MEDICARE: DR. RUBEN TEJADA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	E0881	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053473231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBEN TEJADA M.D.

Provider Business Mailing Address
First Line	:	5212 VILLAGE PKWY
Second Line	:	SUITE 9
City	:	ROGERS
State	:	AR
Zip	:	72758-8104
Country	:	US
Telephone Number	:	479-876-8460
Fax Number	:	479-876-8470

Provider Business Practice Location Address
First Line	:	5212 VILLAGE PKWY
Second Line	:	SUITE 9
City	:	ROGERS
State	:	AR
Zip	:	72758-8104
Country	:	US
Telephone Number	:	479-876-8460
Fax Number	:	479-876-8470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	10/17/2013

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